心力衰竭患者的器械治疗:药物使用是否优化,我们是否针对那些最有可能受益的患者?
Robert Wannamaker1, Roopinder K Sandhu2, Justin A Ezekowitz3
1Division of General Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
CJC open
|September 2, 2025
概括
超过一半的心力衰竭患者在开始指导治疗 (GDMT) 后的六个月内被转诊. 然而,许多患者没有获得最佳的GDMT,一些转诊患者属于益处风险较低的群体.
科学领域:
- 心脏病学
- 医疗器械
- 心脏衰竭的治疗方法
背景情况:
- 在心力衰竭 (HF) 管理中,指导性医疗治疗 (GDMT) 是至关重要的.
- 设备治疗,包括可植入心脏转换器-除器 (ICD) 和心脏再同步治疗 (CRT),在选定的HF患者中起着至关重要的作用.
- 评估与GDMT相关的设备植入的最佳时间和患者选择对于最大限度地使患者受益至关重要.
研究的目的:
- 评估在设备推时接受最佳指导医学治疗 (GDMT) 的心力衰竭患者比例.
- 使用已建立的评分系统评估这些患者的益处风险状况.
- 在专业心力衰竭诊所了解转诊模式和GDMT优化.
主要方法:
- 在2013年1月至2024年8月期间,一项回顾性队列研究分析了250名器件合格的心力衰竭患者.
- 使用修改的心脏功能协作得分来评估指导治疗 (GDMT).
- 使用多中心自动除器植入试验II (MADIT- ICD) 评分来评估患者的益处风险.
主要成果:
- 在接受初级预防治疗的患者中,有54. 4%的患者在开始GDMT后的6个月内被转诊.
- 25% 的转诊患者属于最低的MADIT- ICD益处风险组,这表明潜在益处较低.
- 大部分患者没有服用最大剂量的GDMT,其中多达三分之一的患者至少服用了一种药物,剂量低于目标剂量的50%.
结论:
- 虽然超过一半的符合条件的心力衰竭患者在开始GDMT后的六个月内被转诊用于装置植入,但并非总是实现最佳GDMT.
- 在转诊之前,显著比例的转诊患者处于较低的益处风险类别,这表明了改善患者选择或GDMT优化的潜力.
- 需要进一步的研究来完善转诊标准,并确保对被考虑为器械治疗的心力衰竭患者进行全面的GDMT优化.
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